Unexcited? There May Be a Pill for That
By DANIEL BERGNER
Published: May 22, 2013
Linneah sat at a desk at the Center for Sexual Medicine at Sheppard Pratt in the suburbs of Baltimore and filled out a questionnaire. She read briskly, making swift checks beside her selected answers, and when she was finished, she handed the pages across the desk to Martina Miller, who gave her a round of pills.
The pills were either a placebo or a new drug called Lybrido, created to stoke sexual desire in women. Checking her computer, Miller pointed out gently that Linneah hadn’t been doing her duty as a study participant. Over the past eight weeks, she took the tablets before she planned to have sex, and for every time she put a pill on her tongue, she was supposed to make an entry in her online diary about her level of lust.
“I know, I know,” Linneah said. She is a 44-year-old part-time elementary-school teacher, and that day she wore red pants and a canary yellow scarf. (She asked that only a nickname be used to protect her privacy.) “It’s a mess. I keep forgetting.”
Miller, a study coordinator, began a short interview, typing Linneah’s replies into a database that the medication’s Dutch inventor, Adriaan Tuiten, will present to the Food and Drug Administration this summer or fall as part of his campaign to win the agency’s approval and begin marketing what might become the first female-desire drug in America. “Thinking about your desire now,” Miller said, “would you say it is absent, very low, low, reasonable or present?”
“Low.” This was no different from Linneah’s reply at the trial’s outset two months before.
“When your partner initiated sexual activity over the past eight weeks, did you show avoidance behavior?”
“Like earlier to bed?”
“Yes.” Linneah’s voice lurched louder; she laughed; it was a relief to talk bluntly.
“Do you have pleasant feelings when you’re touched?”
Later, after her appointment, she told me that in fact she has orgasms pretty much every time she and her husband have sex — that wasn’t the problem. “There’s something that’s stopping me from wanting it,” she said. “I don’t know what it is. I can’t tell you what it is.”
She met her husband at a bar nearly two decades ago: she joked with him over a foosball table, watched him clown on the dance floor. “I had a professor at college who talked about ‘the attraction template.’ My husband’s right inside my attraction template,” she said. She remembered his dark hair, his boyish looks, the way she’d felt they fit together, because they were both on the short side. “And he’s a stand-up guy. He has an excellent sense of what’s right and what’s wrong. He can make fun but not in a way that hurts anyone.”
When they were dating and out with other couples, Linneah would think, “I just want to get home with him, I just want to get home with him,” she recalled. But that lust had dwindled. Around the arrival of their second child in 2004, something insidious crept in, partly fatigue but partly something else that she couldn’t name. She talked about her to-do lists, the demands of the kids, “but let’s face it,” she said, “sex doesn’t take that much time.” Rather than feeling as if she still wanted to grab her husband’s hand and hurry him up the stairs in their small brick house, on many nights she waited in bed, somewhat like prey, though the predator was tender, though he was cherished.
Around once a week, her husband tried to reach through the invisible barriers she built — the going up to bed early, the intense concentration on a book, the hoping he was too tired to want anything but sleep. “He’ll move closer to me in bed, or put his arm around me, or rub my back.” She willed herself not to refuse him. And mostly, she didn’t. Usually they had sex about four times each month. But it upset her that she had to force herself and that she put up those barriers to deter him from reaching more often.
“I’m scared that if it’s slimmed to this by now, what’s going to happen as we get older?” she said. “I want to stay close, not just psychologically, physically. I want to stay in love. I have a friend, they have sex so intermittently, every three months. She is so unhappy. I don’t want that to happen to me.” She longed for a cure, a tab of magic. As she got into her car in the parking lot at the center, she hoped that her first set of pills had been placebos, that she’d been given fakes for the first eight weeks, that today she was driving away with the real drug and that their sex life would be transformed.
Half a century ago, the birth-control pill offered women the ability to switch off ovulation, to separate sex from reproduction. It played a part, as the ‘60s got under way, in propelling a host of profound changes, cultural as well as reproductive, societal as well as intimate — in how women saw themselves and lived their lives, starting with the notion of women being above all baby makers and mothers. The promise of Lybrido and of a similar medication called Lybridos, which Tuiten also has in trials, or of whatever chemical finally wins the race for F.D.A. approval, is that it will be possible to take a next step, to give women the power to switch on lust, to free desire from the obstacles that get in its way. “Female Viagra” is the way drugs like Lybrido and Lybridos tend to be discussed. But this is a misconception. Viagra meddles with the arteries; it causes physical shifts that allow the penis to rise. A female-desire drug would be something else. It would adjust the primal and executive regions of the brain. It would reach into the psyche.
Jake Chessum for The New York Times
Beckoned by ads on the radio and in newspapers and on Craigslist, in the fall of 2011 women across America began applying to be among the 420 subjects in the Lybrido and Lybridos studies. Plenty were turned away when the trials filled. Lack of lust, when it creates emotional distress, meets the psychiatric profession’s clinical criteria for H.S.D.D., or hypoactive sexual-desire disorder. Researchers have set its prevalence among women between the ages of about 20 and 60 at between 10 and 15 percent. When you count the women who don’t quite meet the elaborate clinical threshold, the rate rises to around 30 percent. For a minor fraction of all the sexually indifferent (or repelled), the condition has been lifelong, regardless of whom they’re with or how long they’ve been with them. For middle-aged or older women, menopause and its aftermath may play a role, though its importance is much debated. For a sizable segment of the undesiring, the most common antidepressants, the selective serotonin reuptake inhibitors, can be the culprit. Millions of American women are on S.S.R.I.’s, and many of them would have good use for a pill to revive the libido that has been chemically dulled as a side effect of the pill they take to buoy their mood.
But for many women, the cause of their sexual malaise appears to be monogamy itself. It is women much more than men who have H.S.D.D., who don’t feel heat for their steady partners. Evolutionary psychologists argue that this comes down to innate biology, that men are just made with stronger sex drives — so men will settle for the woman who’s always near. But the evidence for an inborn disparity in sexual motivation is debatable. A meta-analysis done by the psychologists Janet Hyde and Jennifer L. Petersen at the University of Wisconsin, Madison, incorporates more than 800 studies conducted between 1993 and 2007. It suggests that the very statistics evolutionary psychologists use to prove innate difference — like number of sexual partners or rates of masturbation — are heavily influenced by culture. All scientists really know is that the disparity in desire exists, at least after a relationship has lasted a while.
Dietrich Klusmann, a psychologist at the University of Hamburg-Eppendorf in Germany, has provided a glimpse into the bedrooms of longtime couples. His surveys, involving a total of almost 2,500 subjects, comprise one of the few systematic comparisons of female and male desire at progressive stages of committed relationships. He shows women and men in new relationships reporting, on average, more or less equal lust for each other. But for women who’ve been with their partners between one and four years, a dive begins — and continues, leaving male desire far higher. (Within this plunge, there is a notable pattern: over time, women who don’t live with their partners retain their desire much more than women who do.)
Lesbian couples seem to fare no better, and maybe worse, in keeping their sexual ardor for each other. The term “lesbian bed death,” coined by the University of Washington sociologist Pepper Schwartz in the ‘80s, has been critiqued as overstatement but not quite as fiction. “In the lesbian community, the monogamy problem is being aired more and more,” Lisa Diamond, a professor of psychology and gender studies at the University of Utah, told me. “For years, gay men have been making open arrangements for sex outside the couple. Now, increasingly, gay women are doing it.”
Klusmann’s results are echoed by Lori Brotto, a psychologist at the University of British Columbia who has worked clinically with scores of H.S.D.D. patients and who recently led the American Psychiatric Association’s attempt to better delineate the condition in The Diagnostic and Statistical Manual of Mental Disorders. (H.S.D.D. is being reconceived as sexual interest/arousal disorder, S.I.A.D.) “The impact of relationship duration is something that comes up constantly,” she told me about her therapy sessions. “Sometimes I wonder whether it” — H.S.D.D. — “isn’t so much about libido as it is about boredom.”
But desire resists comprehension. Whether it is mainly a raw drive or a complex emotion is a question that has bedeviled psychiatry for decades. And the fading of desire can seem impossibly intricate. Is it a result of a lack of intimacy or its cause? One theory holds that it’s a challenge for both sexes to maintain passion over the long-term because it’s threatening to desire the same person from whom we seek security and true understanding. It leaves us feeling too vulnerable. As Stephen A. Mitchell, one of the leaders of relational psychoanalysis, described it: “Sustaining desire for something important from someone important is the central danger of emotional life. What is so dangerous about desiring someone you have is that you can lose him or her.” Mitchell argued that ultimately the emotional meshing and vulnerability of committed relationships can become the most rewarding source of eros. Esther Perel, a couples therapist and author of “Mating in Captivity,” emphasizes a separateness at the heart of longstanding passion. “Many couples confuse love with merging,” she writes. “This mix-up is a bad omen for sex. To sustain élan toward the other, there must be a synapse to cross. Eroticism requires distance.”
“What protects desire in monogamous partnerships is a great empirical question,” Brotto said. “I don’t think there have been any good studies.”
Brotto, who is married and has three children, went on: “I’m a woman in a long-term monogamous relationship. I myself have felt firsthand very high passionate desire, which then wanes. I can relate to my patients completely.” Sometimes she discusses the option of open relationships. But even to contemplate this alternative is to ignite fears in both women and men, and those override the pining for lust.
How much easier it would be if we could solve the insoluble by getting a prescription, stopping off at the drugstore and swallowing a pill.
Jake Chessum for The New York Times
I watched the initial stage of the Lybrido and Lybridos trials at the offices of Dr. Andrew Goldstein, a gynecologist in Washington. Like the rest of the practitioners at the 16 research sites across the country that Adriaan Tuiten contracted to conduct the studies, Goldstein had to make sure that every applicant was in a stable relationship. Tuiten didn’t openly acknowledge monogamy as the core of the desire problem, but he knew he couldn’t use single subjects who might well find new lovers during the course of the trials. Their results might have to be tossed out because, with or without chemical aids, new lovers bring surges of lust.
Goldstein was involved in other desire drug trials, then stopped taking part in them for a while, out of disappointment and frustration. He was optimistic, though, that Tuiten’s company, Emotional Brain, would succeed with the F.D.A.; Tuiten’s approach, he said, was far more scientifically “fine-tuned.” (He doesn’t stand to profit from Lybrido or Lybridos, he says; he is paid his usual fee for each subject’s office visit and also receives around $2,500 a year from Emotional Brain for occasional work on an advisory board.) He recounted for me the way his patients lament the disappearance of lust. “They use terms with real emphasis, words that are violent,” he said. ” ‘This is like someone cut off my arm.’ ‘This is not how I see myself.’ ‘This is like something’s been ripped away from me. Stripped away. Stolen.’ ”
Among the applicants for the trials whom Goldstein interviewed was a law student. After five years with her boyfriend, she couldn’t trick herself into the desire for him she once felt; she could only trick him into believing she still felt it. “I don’t like to hurt his feelings,” she said. “I’m a team player.” There was a divorced mother of three who sensed herself slipping into the same sexual disinterest with her current partner that she recognized from the slow death of her marriage. “When we split up,” she said about her ex-husband, “it was like going through a second puberty. So I attributed what had gone missing to who he was.” She talked about the way her kids had always drained her energy, about getting her disabled son to his therapy appointments. But now that she was starting to feel sexually deadened with her boyfriend, she had doubts about those explanations.
Every woman raised a mix of possible reasons. There were the demands of graduate school, the demands of children, the demands of work, medical issues, men who weren’t always as kind or nearly as engaged as they could be. But at bottom there seemed to be one common cause: they had all grown tired of sex with their long-term partners.
“I just want to know,” a woman asked Goldstein at the end of her interview, after talking about the man she’d spent the last several loving years with, “is this medicine going to work? Am I going to get my freak back?”
One subject in the study was Zita, a 31-year-old who favors frilly blouses and wears a heart-shaped pendant, a gift from her husband. They’ve been married for 6 years, together for 11. “It was great,” she told me about their beginning. “We were like jackrabbits.” Then eagerness became avoidance: there was nighttime cleaning that had to be done, or homework for a physician’s-assistant course that couldn’t wait. She hoped her husband would be asleep by the time she slid into bed. She still found him attractive, “but I don’t know, I don’t know how to explain it. Over time, his sex drive decreased a little, and mine decreased kind of drastically.” The couple had tried some role playing, without much effect for her. One day she was on Craigslist and stumbled on the ad for the trials. She quickly signed up. When she told friends about it, they wanted in, too; they were distressed over the same decline. But there were no spots left.
Jake Chessum for The New York Times
Consider the lengths to which scientists go to try to understand the workings of female desire: Using a laboratory gadget that measures vaginal blood flow while women watch varieties of pornography. Having women wear headgear that tracks the precise movement of their pupils, hundreds of times per second, as they gaze at X-rated images. Studying female hamsters and even arachnids mating as a way to glean insight into women’s sexual psyches. Wiring women’s necks and forearms to what they are told is a polygraph machine while they fill out surveys about their sex lives, their answers then compared with those of women who aren’t wired up — and compared in turn with the responses of men. These are all attempts to see around or beneath the societal messages and cultural influences that may distort women’s sexuality and constrain its expression, even in our seemingly unconstrained times. (Yes, the lie detector had a much bigger effect on the women than the men, greatly increasing the number of partners women said they’d had sex with.)
The equipment can seem bizarre and the laboratory situations comical — picture a woman in a lounge chair with her pants around her knees, a tampon-shaped tube in her vagina and a cord running from this device to a console while she stares at a video of gay men partaking in foreplay — but then, sex research has always had an absurd if valiant quality. In the ‘50s and ‘60s, William H. Masters and Virginia E. Johnson filmed and observed hundreds of subjects having intercourse in their lab, in an effort to determine whether all female climaxes are clitoral in origin. That debate goes on even today. Barry Komisaruk, a neuroscientist at Rutgers University, buys plastic rods, heats them in his oven at home, bends them into dildos shaped to isolate different genital sensations and aims to settle the orgasm question once and for all.
One general principle about women’s desire has been widely embraced since at least as far back as Victorian times and prevails still: that female eros is, innately, much less promiscuous — much more dependent on commitment and trust, much more sparked by closeness, much better suited to constancy — than male sexuality. It has surely been comforting to anyone concerned with the preservation of social order to think that, a few exceptions aside, half the population has a natural predisposition toward sexual stability. In recent decades, this idea has been bolstered by evolutionary psychologists, whose “parental investment theory” goes like this: because men have limitless sperm while women have limited eggs, because men don’t have to invest much in reproduction while women invest not just their ova but also their bodies as they take on the tolls and risks of pregnancy and childbirth, males have been hard-wired, since eons ago, to expand their genetic legacy by spreading their cheap seed, while females are inherently made to maximize their investment by being choosy, by securing a male likely to be a good long-term provider.
The logic turns our assumptions about male and female sexuality into inborn inevitabilities. But to read the journal articles that promote this line of reasoning is to see the flimsiness of its foundation. In a seminal 1993 paper, whose conclusions have made their way from academia into popular consciousness, David M. Buss and David P. Schmitt, psychology professors now at the University of Texas at Austin and at Bradley University in Peoria, Ill., highlighted research showing that, in comparison to college-age men, college-age women say they want far fewer sexual partners over the course of their lifetimes. Similar evidence runs throughout the article. But what exactly does this type of data demonstrate: that women are innately less promiscuous in their longings than men, or that women are taught to feel that they should be?
Studies conducted recently are beginning to hint that female eros isn’t in the least programmed for fidelity. These range from close focus on the sexual habits of our primate ancestors to research exploring women’s wish for casual sex. An experiment led by Samantha Dawson, a Ph.D. student in clinical psychology at Queen’s University, in Kingston, Ontario, and another by Stephanie Both, a psychologist and assistant professor at Leiden University Medical Center in the Netherlands, looked at the issue in another way. Heterosexual women and men watched pornographic film clips while their vaginas and penises were monitored. The subjects watched a one-minute sex scene repeatedly, with breaks in between to let genital blood flow return to a baseline state. Dawson’s and Both’s results show women’s responses leaping at first, then, in Dawson’s study, tracking the rapid downturn of the men, and in Both’s, plummeting while the men’s reactions stayed surprisingly constant. When the researchers introduced what are called “novel stimuli,” in this case new clips of pornography, “vaginal pulse amplitude,” like penile engorgement, spiked immediately.
In research published last year, Meredith Chivers, a psychologist at Queen’s University, played pornographic audiotapes for heterosexual women and compared, among other things, genital reactions to scenarios involving a handsome male stranger or a hunky male friend. The friends made the machine flatline. The strangers made it jump.
How much can we extrapolate from studies like these? Maybe conclusions aren’t in order, but certainly we should doubt what evolutionary psychology has taught us.
Jake Chessum for The New York Times
The search for a female-desire drug has been an obsession of the pharmaceutical industry for more than a decade, largely because the release of Viagra, in 1998, showed that gigantic sums of money can be made with a quick chemical solution to sexual dysfunction. But while Viagra and its competitors deal with the simple hydraulics of impotence, the most troubling difficulty for men, the psychological complexity of depleted lust has so far defeated industry giants. Yet it’s important to note that Viagra isn’t entirely without influence on the mental state of desire. The mechanics of the body and the mysteries of the mind are intertwined. Give a man an erection, and his sensitized nerves and enhanced feelings of power are going to feed his drive. Women, research has shown, are less cognizant of genital arousal, and probably for this reason, Viagra-like substances haven’t done enough to raise women’s ratings of desire in past experiments, even while the chemicals have added to blood flow. Tuiten’s Lybrido employs a Viagra-like chemical as one-half of its arsenal, in the hope that it will be effective in combination with a substance that more directly targets the brain.
When Tuiten, a disheveled, youthful 58-year-old, told me the story of how he conceived of Lybrido and Lybridos, there was something sad and funny and metaphorically perfect about it — it was a tale of scientific ingenuity stemming from a young man’s broken heart. Tuiten was in his mid-20s when his girlfriend, a woman he’d been in love with since he was 13, abruptly decided to leave him. “I was — flabbergasted. You can say that?” he asked me, making sure, in his choppy English, that he was using the right word. “I was shocked. I was suffering.” He was an older university student at the time; before that, he’d been a furniture maker. The breakup inspired a lifelong quest to comprehend female emotion through biochemistry and led to his career as a psychopharmacologist. “I’m a little bit — not insane,” Tuiten said. “But. There became a need for me to understand my personal life in this way.”
The neural networks of eros, though, are only vaguely known. Tiny subregions and crucial pathways in the brain have been identified — blurrily, speculatively. Some progress has been made by looking at what sites in the brain light up when people watch slide shows of pornography while lying in magnetic-resonance-imaging cylinders. But the images just aren’t exact enough. The brain’s interwoven networks are too intricate for the technology to properly view them.
So we rely on rats. And one of the world’s masters of rat lust is Jim Pfaus, a professor of psychology and neuroscience at Concordia University in Montreal, who wears hoop earrings and used to sing in a punk band called Mold. The various drug companies, including Tuiten’s, regularly consult with him. A few floors below his office, hundreds of rats court and mate in stacks of Plexiglas cages. Pfaus and his grad students inject the rodents with this or that compound to block one aspect of desire’s biochemistry and isolate another. Or they kill the rats right after a moment of craving or copulation. The brain is then extracted, frozen and shaved into wafers, microns thin, by a device resembling a mini cold-cut slicer. Pfaus peers at these specimens under a microscope to figure out which clusters of neural cells went into metabolic overdrive while the rodent was in a sexual frenzy.
As Pfaus explains it, sexual desire for both women and men seems to begin in two low-lying brain zones: the medial preoptic area, which looks like a pair of minuscule oblong balls, and the ventral tegmental area, which is shaped something like a canoe. From this primitive center, the neurotransmitter dopamine, the molecular essence of desire, radiates outward through the brain. “A dopamine rush is a lust-pleasure, it’s a heightening of everything,” Pfaus says. “It’s smelling a lover up close — a woman inhaling that T-shirt. . . . It’s wanting to have; it’s wanting more.”
A number of other biochemical ingredients are critical to the most basic understanding of sexuality. But two of them — the hormone testosterone and the neurotransmitter serotonin — are especially important. Rising from the ovaries and from the adrenal glands that sit atop the kidneys, testosterone rides the bloodstream to the brain and, by means not fully known, stokes the production and release of dopamine. (Blood-borne estrogen, which derives from testosterone, may also be involved in this process.) And then there’s serotonin, dopamine’s foil. It allows the advanced regions of the brain, the domains that lie high and forward, to exert what is termed executive function. Serotonin is a molecule of self-control. It instills calm, stability, coherence (and, too, a sense of well-being, which is why S.S.R.I.’s, by bathing the brain in serotonin, can counter depression). Roughly speaking, dopamine is impulse; serotonin is inhibition and organization. And in sexuality, as in other emotional realms, the two have to work in balance. If dopamine is far too dominant, craving can splinter into attentional chaos. If serotonin overwhelms, the rational can displace the randy.
Yet knowing the biochemical components of a woman’s desire is one thing; manipulating them quite another. LibiGel, a testosterone gel made by BioSante, which reached women’s bloodstreams through the skin, was one of the medicines that preceded Lybrido and Lybridos. When F.D.A. trials ended in 2011, the results showed that the product didn’t do any more for sexual interest than a placebo.
Three years ago, Linneah took part in a trial of another drug, Boehringer Ingelheim’s Flibanserin, a nonhormonal pill that tinkered directly with neurotransmitter systems. Linneah swallowed a dose every day — and waited. So did her neighbor and another friend, wives who didn’t much desire their husbands anymore, either. They’d all taken reassurance in one another’s indifference and shared their amazement about another neighbor: “She was married as long as I was,” Linneah remembered, “and she had four kids and she was P.T.A. president, and she was ready to go with her husband 24/7, and we were all like, Wha?” That spring of the Flibanserin trial, Linneah and her friends agreed that they weren’t sensing any shift. Then, as now, Linneah thought maybe she’d landed in a placebo group. When Boehringer Ingelheim presented its data, an F.D.A. advisory board was not impressed with the results.
Bremelanotide, another nonhormonal medication (this one taken by nasal inhaler), was tested in 2006 and 2007. It generated, in a fair percentage of subjects, great waves of lust. Unfortunately, there were side effects like sudden jumps in blood pressure and bouts of vomiting. (LibiGel, Flibanserin and Bremelanotide are again being tested; this time, Bremelanotide is being delivered via injection.)
Tuiten’s pills work somewhat differently than the drugs that came before them. For one thing, both Lybrido and Lybridos contain two active chemicals, timed so that their effects converge. Each drug tampers with the interplay between serotonin and dopamine, giving dopamine, carrier of lust, a temporary edge.
Both drugs have a peppermint-flavored testosterone coating that melts in the mouth. When the exterior is gone, the woman swallows a delayed-release inner tablet. In Lybrido, this inner pill is a close cousin of Viagra. The idea is that the Viagra-like molecule, by making extra blood flow to the genitals and adding to swelling and sensation, will work in conjunction with the testosterone. Together they will stir the mind to be more aware of erotic impulses; together they will help spark dopamine networks. Lybridos uses a compound called buspirone instead of the Viagra-like substance. Buspirone was originally used as an anti-anxiety medication, and if taken every day it can elevate serotonin in the brain. But as long as it’s taken no more than every other day, it has a unique short-term effect: for a few hours, serotonin is suppressed.
To help predict which women will most benefit from which drug, Tuiten has blood drawn from each subject and examines genetic markers related to brain chemistry. Tuiten also asks subjects questions about their comfort with sexual feelings and fantasies. Since our dopamine and serotonin networks are reinforced or attenuated by all we learn, all we think and do, he believes that the answers may provide clues about a given woman’s neurotransmitter systems, which he uses as part of his diagnostic method.
This interplay of experience and neural pathways is widely known as neuroplasticity. The brain is ever altering. And it is neuroplasticity that may help explain why hypoactive sexual desire disorder is a mostly female condition, why it seems that women, more than men, lose interest in having sex with their long-term partners. If boys and men tend to take in messages that manhood is defined by sex and power, and those messages encourage them to think about sex often, then those neural networks associated with desire will be regularly activated and will become stronger over time. If women, generally speaking, learn other lessons, that sexual desire and expression are not necessarily positive, and if therefore they don’t think as much about sex, then those same neural networks will be less stimulated and comparatively weak. The more robust the neural pathways of eros, the more prone you are to feel lust at home, even as stimuli dissipate with familiarity and habit.
“We had sex five times a week when before it was once a week,” Zita told me shortly after she’d finished her supply of Lybrido. And she wasn’t enthusiastic about that weekly intimacy. With the drug, she said, “I wanted to have sex even after we had sex. I would feel horny, and I got like a throbbing sensation, like I had to do something or it was going to bother me all night. I would just want more.” When I asked how her husband felt about her taking the medication, she laughed.”Happy,” she said.
Tuiten published some results from small, preliminary trials in the March issue of The Journal of Sexual Medicine. His full data, which he has just finished tabulating and will soon be taking to the F.D.A., show Lybrido bestowing unmistakable benefits in desire — and in rates of orgasm. (The outcomes for Lybridos aren’t thoroughly compiled, but he says that early results look about as positive.) Tuiten is confident that the F.D.A. will send him to do another larger set of trials, which will involve about 1,200 subjects. Plenty of drugs fail at that stage of replication. But if all goes well, by 2016, Lybrido and Lybridos might be on the market.
Is it possible, after all, that through the pharmaceutical industry a fairy-tale ending could come to pass? Perhaps the fantasy that so many of us harbor, consciously or not, in the early days of our relationships, that we have found a soul mate who will offer us both security and passion, till death do us part, will soon be available with the aid of a pill.
But of course swallowing a tablet can take us only so far. Chemically enhancing a woman’s desire might play out in all kinds of ways within a relationship. Some couples might feel closer, others might feel desolate because, despite more sex, their bond isn’t stronger. Wives might yearn for the old seductive efforts of their husbands, even if those gestures stopped working long ago. Women might feel yet more pressure to perform: Why not get that prescription? their partners might ask; why not take that pill? And men, if they are willing to confront the truth, might not be so happy about the reminder, as their partners reach for the pill bottle, that their women need chemical assistance to want them. All the agonies that have existed since the dawn of monogamy will still pertain, many of them coming down to the craving to feel special.
Beyond what might happen in millions of bedrooms, it’s even more difficult to foresee what societal transformations might be stirred. Just as with the birth-control pill, a foreboding not only about sex itself but also about female empowerment may be expressed in a dread of women’s sexual anarchy. Over the last decade, as companies chased after an effective chemical, there was fretting within the drug industry: what if, in trials, a medicine proved too effective? More than one adviser to the industry told me that companies worried about the prospect that their study results would be too strong, that the F.D.A. would reject an application out of concern that a chemical would lead to female excesses, crazed binges of infidelity, societal splintering.
“You want your effects to be good but not too good,” Andrew Goldstein, who is conducting the study in Washington, told me. “There was a lot of discussion about it by the experts in the room,” he said, recalling his involvement with the development of Flibanserin, “the need to show that you’re not turning women into nymphomaniacs.” He was still a bit stunned by the entrenched mores that lay within what he’d heard. “There’s a bias against — a fear of creating the sexually aggressive woman.”
Gaining control of their reproduction in the ‘60s affected not just women’s sex lives but also everything from their social standing to economic empowerment. What might it mean for conventional structures if women could control, with a prescription, the most primal urge? So many things, personal and cultural, might need to be recalibrated and renegotiated, explicitly or without acknowledgment. The cumulative effect of all those negotiations could be hugely transformative, in ways either thrilling or threatening, depending on your point of view.
For her part, Linneah didn’t see herself as doing anything revolutionary. This was about her marriage. She said that if this drug didn’t work, she would sign up for the next experimental medication that came along. She seemed untroubled by the fact that we live in an age when it’s possible to take a pill for nearly everything, or by the paradox that one of the problems this medication might be addressing is the desire-killing side effect of yet another type of psychotropic chemical, the S.S.R.I.’s. For her, the existence of the antidepressants that so many others take was proof that her problem would be solved.
“They’ve got all these meds for all these other psychiatric issues,” she said, before driving away with her new batch of pills. “Something’s got to pop up that can help with this. Right? Right?”